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Online ISSN 1827-1847
Peinetti F., Maione M., Cifiello B. I., Piccolo D., Imperial H.
Unità Operativa di Chirurgia Vascolare ed Angiologia Ospedale Regionale Valle d’Aosta, Aosta
Background. Endovascular and laparoscopic techniques continue to be developed in the attempt to further establish alternative safe, durable techniques to treat aortoiliac disease. In our experience we introduced the left subcostal minilaparotomy in 1998, for a less retroperitoneal dissection of the abdominal aorta. The advantage of minilaparotomy aortic exposure to treat aortic disease (AAA and PAD) was analysed in comparison with conventional open repair with midline or flank incision with extensive retroperitoneal dissection.
Methods. From January 1998 to December 2000, 134 patients underwent surgery for aortic disease in the Vascular Surgery and Angiology Unit, Aosta Valley Regional Hospital. They were subdivided into 3groups by surgical approach: 1) group A: midline incision (52 patients: 40%); 2) group B: flank incision (44 patients: 33%); 3) group C: left subcostal minilaparotomy (38 patients: 27%). We evaluated clinical characteristics, mortality, morbidity, early and late complications, length of hospitalisation, comparing them among the 3 groups.
Results. No statistically significant difference was found among the 3 groups for age, gender, risk factors or associated vascular disease. Operative mortality and morbidity and were also comparable among the 3 groups. The results for group C demonstrate the potential advantage of minimally invasive surgical techniques: early removal of nasogastric suction, quicker progression to regular diet and mobility, shorter hospitalisation.
Conclusions. Based on our preliminary experience, we conclude that treatment of aneurysm or aortic disease with minilaparotomy repair leads to a significant improvement in recovery without significant changes in morbidity or mortality. It is a feasible and safe technique offering long-term durability, and is a safe alternative to be considered by the vascular surgeon.
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